Heart failure constitutes the most frequent and expensive hospital discharge diagnosis in the United States, costing annually over $10 billion with over 900,000 hospital admissions. Care of patients with chronic heart failure is most efficient when patients have frequent communication with their providers, a full understanding of their illness and the ability to control their health care by participation in clinical decisions. They are often managed by telephone reporting to a health professional. To facilitate patient to provider communication, Insight Telehealth Systems, Inc. supported by a Phase one SBIR, has developed an Internet-based communication system (ITS MyHealthfile) that provides heart failure patients with frequent communication with their health care providers for management of their medical status and allows patients to gain understanding and control of their health care. Re-hospitalization due to medication noncompliance, insufficient discharge planning or follow up, and failure to seek prompt medical treatment when symptoms are exacerbated, are reduced with communication systems that allow frequent contact between patients and their providers. The proposed Phase two study will expand the capability and functionality of our initial system design, and examine the economic and clinical outcome of this Internet based asynchronous communication system in a cohort of heart failure patients to determine the impact on cost of care, stability of heart failure status, and patient participation in their chronic disease management. Our research partner in this Phase-2 application is the Heart Failure and Transplantation Program of Temple University Medical Center, which is a nationally recognized program that has a large base of patients with class 3 or class 4 heart failure. We expect this program to improve communications between patient and health care providers, reduce the number of hospital admissions, and result in a more stable medical condition in these patients. Upon completion of this study, our communication product will be positioned to become an important commercial product for health care communication.